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Future of HIV in VA. Office of Public Health Department of Veterans Affairs Maggie Czarnogorski, MD Deputy Director, HIV, Hepatitis, and Public Health Pathogens Program [email protected] April 2012. Office of National AIDS Policy. National HIV/AIDS Strategy Goals.

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future of hiv in va

Future of HIV in VA

Office of Public Health

Department of Veterans Affairs

Maggie Czarnogorski, MD

Deputy Director, HIV, Hepatitis, and Public Health Pathogens Program

[email protected]

April 2012

national hiv aids strategy goals
National HIV/AIDS Strategy Goals
  • Reducing New HIV infections
  • Improving Access to Care and Health Outcomes
  • Reducing Health Disparities
  • Working across federal agencies
engagement in care cascade va vs community
Engagement in Care Cascade:VA vs. Community

30,000

25,000

20,000

15,000

10,000

5,000

0

Gardner EM, et al. Clin Infect Dis. 2011;52:793-800

va hiv testing policy changes august 17 2009
VA HIV Testing Policy Changes August 17, 2009
  • VA National HIV Testing Policy revised
    • After Section 124 repealed, VA was able to revise policy to promote widespread routine HIV testing
    • Routinely offer HIV testing to all Veterans
    • Eliminate written informed consent and prescribed pre- and post-test counseling
    • Verbal consent still required and must be documented in medical record
    • Written educational materials about HIV testing must be provided to patients

VHA Informed Consent Handbook 1004.01: August 17th, 2009

VHA Directive 2009-036, August 17, 2009

va hiv testing rates data collection methods
VA HIV Testing Rates: Data Collection Methods
  • Data Extract Routine installed at all facilities to generate HIV test reports by Calendar Year (CY)
  • Data collected on all outpatients in that CY
    • Number with HIV test ever done
    • Number with HIV test done in that CY
    • Number with positive result in that CY
  • In 2011, added Gender, Race/Ethnicity, Age information
veterans ever tested for hiv by year 2009 2011
Veterans Ever Tested for HIV by Year2009-2011

13.5% Ever Tested n= 795,126

20% Ever Tested n= 1,221,328

9.2% Ever Tested n=524,267

2009

2010

2011

Outpatient Visits n= 5,713,265

Outpatient Visits n= 5,888,599

Outpatient Visits n= 6,114,034

percent of veterans ever tested for hiv by visn 2009 2010 2011
Percent of Veterans EVER Tested for HIV, by VISN: 2009, 2010, 2011

Percent Outpatients EVER Tested for HIV

VISN

percentage of hiv positive tests in cy 2011 by visn
Percentage of HIV Positive Tests in CY 2011, by VISN

0.7%

Mean: 0.38%

Median: 0.35%

Range: 0.14-0.64%

*CDC Threshold for routine HIV testing

0.6%

0.5%

0.4%

% HIV Tests Performed in 2010 that were Positive

0.3%

0.2%

*

0.1%

VISN

hiv seropositivity in cy 2011 by age and gender
HIV Seropositivity in CY 2011 by Age and Gender

0.7%

0.6%

0.5%

0.4%

0.3%

0.2%

0.1%

0.0%

va national hiv testing data for 2009 2010 and 2011
VA National HIV Testing Data for 2009, 2010 and 2011

Abbreviations: CY= calendar year; HIV = human immunodeficiency virus

va initiatives to improve hiv testing rates 2009 2011
VA Initiatives to Improve HIV Testing Rates 2009-2011
  • Legislative and Policy Changes
    • Verbal consent for testing
    • Routine offer of HIV testing to Veterans
  • Routine HIV test clinical reminder
  • Funding for facility-level quality improvement projects
    • Clinical HIV testing
    • Laboratory
    • Women’s Health
    • Homeless Veteran Stand Downs
  • Social marketing campaign
conclusions
Conclusions
  • VA is the largest US provider of HIV care
  • The quality of HIV care VA provides is excellent
  • The percentage of Veterans ever tested for HIV more than doubled in two years
  • Many Veterans in VA care have still not been tested for HIV
  • In 2011, all VISNs had an HIV seropositivity rate above the CDC threshold (>0.1%) for routine HIV testing
  • Routine HIV testing is warranted in VA
  • VA will continue to provide timely linkage of care
the future
The Future
  • Continued Excellence of Care
  • Improve Access and Expand Workforce
    • Telehealth/SCAN-ECHO
    • Patient Centered Teams
  • Targeted approaches with Special Populations to decrease disparities
    • New Veterans
    • Women
    • Homeless, Incarcerated
    • Regional
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